FDA Approval and Formulary Decisions in Women's Health Treatments
Menopause therapy coverage varies by insurance type and is dependent on FDA approval status, clinical guidelines and prior authorizations, all of which are best navigated with the help of a managed care pharmacy expert, according to Susan Cantrell, CEO, Academy of Managed Care Pharmacy.
Coverage for different therapies, specifically menopause symptom treatment, varies by FDA approval status, which relies on clinical data and prior authorizations, according to Susan Cantrell, CEO of the Academy of Managed Care Pharmacy.
“There's a balance of clinical decision-making, ensuring appropriate therapy, and also making sure that we try the more established therapies before moving on to something that might be costlier and less tried and true,” Cantrell said in a recent video interview with Managed Healthcare Executive.
Susan Cantrell
Cantrell cited migraines, which are not specifically a women’s health issue but do affect women more than men. Globally, migraines affect 21% of women and 10% of men, according to a paper published in Neurological Sciences.
“How do we make sure that the therapies that are out there that effectively treat and, in some cases, prevent migraine are being used appropriately?” Cantrell said. “That's where those formulary decisions and those clinical guidelines by the medical specialty societies come into play.”
Cantrell added that having healthcare coverage with a pharmaceutical benefit is critically important so that members can fully understand their benefit details.
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